resourceType: Task
id: cdex-task-example20
meta:
  extension:
  - url: http://hl7.org/fhir/StructureDefinition/instance-name
    valueString: CDex Task Example 20
  - url: http://hl7.org/fhir/StructureDefinition/instance-description
    valueMarkdown: '**Prior-Auth Attachment Request Example:**   Prior Authorization
      Attachment Request with a POU of "coverage authorization" sent by payer to a
      provider requesting a signed History and physical (H&P) note.'
  profile:
  - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request
contained:
- resourceType: Patient
  id: patient
  meta:
    profile:
    - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics
  identifier:
  - use: usual
    type:
      coding:
      - system: http://terminology.hl7.org/CodeSystem/v2-0203
        code: MB
        display: Member Number
      text: Member Number
    system: http://example.org/cdex/payer/member-ids
    value: Member123
  - use: usual
    type:
      coding:
      - system: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
        code: pat
        display: Patient Account Number
      text: Patient Account Number
    system: http://example.org/cdex/provider/patient-ids
    value: PA-123
  name:
  - family: Shaw
    given:
    - Amy
  birthDate: '1987-02-20'
- resourceType: PractitionerRole
  id: practitionerrole
  meta:
    profile:
    - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole
  practitioner:
    identifier:
      system: http://hl7.org/fhir/sid/us-npi
      value: '9941339100'
  organization:
    identifier:
      system: http://hl7.org/fhir/sid/us-npi
      value: '1234567893'
identifier:
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
      code: tracking-id
      display: Tracking Id
    text: Re-Association Tracking Control Number
  system: http://example.org/payer
  value: trackingid789
# ========== add "administrative reference number ============
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
      code: admin-ref-number
      display: Administrative Reference Number
    text: Administrative Reference Number
  system: http://example.org/payer
  value: adminrefnumber123

# ======================================================================

status: requested
intent: order
code:
  coding:
  - system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
    code: attachment-request-code
  text: Coded Attachment Request
for:
  reference: '#patient'
authoredOn: '2022-06-17T16:16:06Z'
lastModified: '2022-06-17T16:16:06Z'
requester:
  identifier:
    system: http://example.org/cdex/payer/payer-ids
    value: Payer123
owner:
  reference: '#practitionerrole'
reasonCode:
  coding:
  - system: http://hl7.org/fhir/claim-use
    code: preauthorization
    display: Preauthorization
  text: preauthorization
reasonReference:
  identifier:
    system: http://example.org/cdex/payer/claim-ids
    value: Preauth123
restriction:
  period:
    end: '2022-06-21'
input:
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
      code: attachments-needed
  valueCodeableConcept:
    coding:
    - system: http://loinc.org
      code: 11506-3
      display: Progress note
    text: Progress note
  extension:
  - url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber
    valueInteger: 1
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
      code: signature-flag
  valueBoolean: true
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
      code: payer-url
  valueUrl: http://example.org/cdex/payer/$submit-attachment
- type:
    coding:
    - code: purpose-of-use
      system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
  valueCodeableConcept:
    coding:
    - code: COVAUTH
      system: http://terminology.hl7.org/CodeSystem/v3-ActReason
      display: coverage authorization